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CLASSIFICATION
MEDICATION
ROUTE OF
ADMINISTRATION
INDICATIONS
ACTIONS
Cholinesterase inhibitor
Antispasticity agent
Cholinergic
Antiarrhythmics--- anticonvulsants
Edrophonium (Tensilon)
Neostigmine (Prostigmin)
Pyridostigmine (Mestinon)
Baclofen (Lioresal)
Dilantin (Phenytoin)
IV
PO,IM,SQ: Prostigmin
PO, IM, IV: Mestinon
PO
PO, IV
Diagnosis of myasthenia gravis.
Assessment of adequacy of
anticholinesterase therapy in myasthenia
gravis. Differentiating myasthenic from
cholinergic crisis.
Reversal of non-depolarizing
neuromuscular blocking agents.
Symptomatic treatment of myasthenia
gravis
Relief of muscle spasticity, bowel
and bladder function may also be
improved.
Treatment / prevention of tonic-clonic (grand mal)
seizures and complex seizures.
Unlabeled uses:
Management of neuropathic pain, including
trigeminal neuralgia.
Inhibits enzyme cholinesterase, allows
accumulation of acetylcholine at the
myoneural junction, restoring normal
transmission of nerve impulses.
Improvement in muscle strength in
symptomatic treatment of myasthenia
gravis by inhibiting the breakdown of
acetylcholine and prolongs the effect
Inhibits reflexes at the spinal level.
Limits seizure propagation by altering ion transport.
May also decrease synaptic transmission.
Cholinergic crisis, seizures, Miosis
Increased intestinal and skeletal muscle
tone, Bronchial and ureteral constriction,
Bradycardia, Increased salivation,
Lacrimation
Sweating, Hypotension
Abdominal cramps, diarrhea, vomiting,
nausea
Ataxia, Seizures, Dizziness,
Drowsiness,
Fatigue, Weakness,
Confusion, Depression,
Headache, Insomnia,
Edema, Hypotension,
Nausea, Constipation
Pruritus, rash, Hyper-glycemia,
Weight gain
Hypersensitivity reactions.
Ataxia, Agitation, Coma,
Drowsiness, Headache,
Nervousness, Weakness
Hypotension, Nausea, anorexia, vomiting,
Gingival hyperplasia
Hypocalcemia, Back pain, pelvic pain, Rashes,
Weight loss, Dry mouth
Acts within 30-60 seconds and has an
extremely short duration of action, seldom
exceeding 10 minutes.
SIDE EFFECTS
Miosis, Increased intestinal and skeletal
muscle tone,
Bronchial constriction,
Bradycardia (may lead to increased
bradycardia in patients receiving digoxin)
Increased salivation, Lacrimation,
Sweating, Seizures, Dizziness,
Abdominal cramps, diarrhea, dysphagia,
Nausea, Vomiting
Incontinence, Abdominal cramps,
anorexia, anxiety, bronchiolar spasm,
cardiac arrhythmias and arrest,
convulsions, ptosis, respiratory arrest,
urinary frequency and incontinence
NURSING
IMPLICATIONS
A physician should be present when this
drug is administered
Assessment: monitor respiratory status,
cardiac status and for other possible side
effects listed above.
Should not be given to patients with active
asthma, bradycardia, hypotension
Antidote: Atropine 0.4 to 0.5 mg IV
A physician should be present when this
drug is used IV.
Oral and parenteral doses are not
interchangeable.
PO: Administer with food or milk to
minimize side effects, administer 30
minutes prior to meals for patients who
have difficulty swallowing
Assessment: pulse, respiratory rate, B/P
prior to administering, neuromuscular
status, vital capacity, ptosis, diplopia,
chewing, swallowing, hand grasp, gait
prior to administering and at peak effect.
Assess for overdosage and underdosage. Monitor for postoperative ileus
and urinary retention. Watch
BUN/Creatinine because dose may need
adjusted with renal failure.
Patient Teaching:
Patient should be instructed to notify
physician/ primary care provider of any
weakness of the intercostals muscles, a
decrease in diaphragmic movement,
dyspnea, breathlessness
Patient should be instructed to take
medication as ordered; not to skip dose or
double up on a missed dose
Patients with dysphagia must take po
medication on time; may not be able to
swallow if not taken on time
Instruct patient to report any muscle
weakness that occurs 3 or more hours
after medication administration, this is a
major symptom of myasthenic crisis
Instruct patient to report any difficulty with
vision or swallowing
Patients should be instructed to carry
medical alert regarding condition
PO:
Administer with milk or food to
minimize gastric irritation.
For orally disintegrating tablets, just
prior to administration place tablet on
tongue with dry hands. Table will
disintegrate, then swallow with water
or saliva.
Assess muscle spasticity before and
periodically during therapy.
Observe patient for drowsiness,
dizziness, or ataxia.
Patient / Family Teaching
Instruct patient to take baclofen as
directed. Take a missed dose within
1 hr; do not double doses. Caution
patient to avoid abrupt withdrawal of
this medication, may precipitate an
acute withdrawal reaction
(hallucinations, increased spasticity,
seizures, mental changes,
restlessness)
Instruct patient to avoid driving until
response to drug is known.
Avoid concurrent use of alcohol or
other CNS depressants
Assess: Neuralgia: Assess pain, (locations,
duration, intensity, precipitating factors) prior to and
periodically throughout therapy.
Serum phenytoin levels should be routinely
monitored.
Patient / Family Education:
PO: Administer with or immediately after meals to
minimize GI irritation.
Shake liquid preparations well before pouring.
Do not interchange chewable phenytoin tablets with
phenytoin sodium capsules.
May cause drowsiness or dizziness. Caution patient
to avoid driving or other activities requiring alertness
until response to medication is known.
Advise patient to carry identification at all times
Instruct patient on importance of maintaining good
dental hygiene and seeing dentist frequently for
teeth cleaning.
Emphasize the importance of routine exams to
monitor progress/ efficacy of drug
Advise patient that brands of phenytoin may not be
equivalent.
Advise the patient that phenytoin may color urine
pink, red, or reddish brown, but change of urine
color is not significant.
Advise patient not to take phenytoin within 2-3 hrs of
antacids or antidiarrheals.
Decrease in muscle spasticity and
associated musculoskeletal pain with
increased ability to perform activities
of daily living
Relief of pain due to neuralgia
Antidote: Atropine 0.4 to 0.5 mg IV
EXPECTED
OUTCOMES
Short-lived improvement in muscular
function in patients with myasthenia gravis
CLASSIFICATION
Cholinesterase inhibitor
Improved muscular function in patients
with myasthenia gravis
Cholinergic
Antispasticity agent
Antiarrhythmics--- anticonvulsants
CLASSIFICATION
MEDICATION
NURSING IMPLICATIONS
Cholinesterase inhibitor
Cholinergic
Antispasticity agent
Antiarrhythmics--anticonvulsants
Edrophonium (Tensilon)
Neostigmine (Prostigmin)
Pyridostigmine (Mestinon)
Baclofen (Lioresal)
Dilantin (Phenytoin)
A physician should be present when
this drug is administered
A physician should be present when
this drug is used IV.
Oral and parenteral doses are not
interchangeable.
PO: Administer with food or milk to
minimize side effects, administer 30
minutes prior to meals for patients
who have difficulty swallowing
Assessment: pulse, respiratory rate,
B/P prior to administering,
neuromuscular status, vital capacity,
ptosis, diplopia, chewing, swallowing,
hand grasp, gait prior to administering
and at peak effect. Assess for
overdosage and under-dosage.
Monitor for postoperative ileus and
urinary retention. Watch
BUN/Creatinine because dose may
need adjusted with renal failure.
Patient Teaching:
Patient should be instructed to notify
physician/ primary care provider of
any weakness of the intercostals
muscles, a decrease in diaphragmic
movement, dyspnea, breathlessness
Patient should be instructed to take
medication as ordered; not to skip
dose or double up on a missed dose
Patients with dysphagia must take po
medication on time; may not be able
to swallow if not taken on time
Instruct patient to report any muscle
weakness that occurs 3 or more
hours after medication administration,
this is a major symptom of
myasthenic crisis
Instruct patient to report any difficulty
with vision or swallowing
Patients should be instructed to carry
medical alert regarding condition
PO:
Administer with milk or food to
minimize gastric irritation.
For orally disintegrating tablets, just
prior to administration place tablet on
tongue with dry hands. Table will
disintegrate, then swallow with water
or saliva.
Assess muscle spasticity before and
periodically during therapy.
Observe patient for drowsiness,
dizziness, or ataxia.
Patient / Family Teaching
Instruct patient to take baclofen as
directed. Take a missed dose within
1 hr; do not double doses. Caution
patient to avoid abrupt withdrawal of
this medication, may precipitate an
acute withdrawal reaction
(hallucinations, increased spasticity,
seizures, mental changes,
restlessness)
Instruct patient to avoid driving until
response to drug is known.
Avoid concurrent use of alcohol or
other CNS depressants
Assess: Neuralgia: Assess pain,
(locations, duration, intensity,
precipitating factors) prior to and
periodically throughout therapy.
Serum phenytoin levels should be
routinely monitored.
Patient / Family Education:
PO: Administer with or immediately
after meals to minimize GI irritation.
Shake liquid preparations well before
pouring.
Do not interchange chewable
phenytoin tablets with phenytoin
sodium capsules.
May cause drowsiness or dizziness.
Caution patient to avoid driving or
other activities requiring alertness
until response to medication is known.
Advise patient to carry identification at
all times
Instruct patient on importance of
maintaining good dental hygiene and
seeing dentist frequently for teeth
cleaning.
Emphasize the importance of routine
exams to monitor progress/ efficacy of
drug
Advise patient that brands of
phenytoin may not be equivalent.
Advise the patient that phenytoin may
color urine pink, red, or reddish
brown, but change of urine color is
not significant.
Advise patient not to take phenytoin
within 2-3 hrs of antacids or
antidiarrheals.
Decrease in muscle spasticity and
associated musculoskeletal pain with
increased ability to perform activities
of daily living
Relief of pain due to neuralgia
Assessment: monitor respiratory
status, cardiac status and for other
possible side effects listed above.
Should not be given to patients with
active asthma, bradycardia,
hypotension
Antidote: Atropine 0.4 to 0.5
mg IV
Antidote: Atropine 0.4 to 0.5
mg IV
EXPECTED OUTCOMES
Short-lived improvement in muscular
function in patients with myasthenia
gravis
Improved muscular function in
patients with myasthenia gravis
CLASSIFICATION
MEDICATION
ROUTE OF ADMINISTRATION
INDICATIONS
ACTIONS
SIDE EFFECTS
NURSING IMPLICATIONS
EXPECTED OUTCOMES
Anticonvulsant
Interferon
Interferon
Corticosteroids
Carbamazepine (Tegretol)
Interferon beta-1b (Betaseron)
Interferon beta -1a Avonex, Rebif
Prednisone
PO
SQ
IM: AvonexSQ: Rebif
PO, IV
Decrease pain in trigeminal neuralgia;
prevent seizures; decrease mania in
Bipolar disorder
Management of relapsing-remitting
multiple sclerosis in ambulatory
patients.
Management of relapsing forms of
multiple sclerosis in ambulatory
patients.
Autoimmune disorders; inflammatory
conditions: used in exascerbations of
Multiple Sclerosis
Decreases synaptic transmission in the
CNS by affecting sodium channels in
neurons.
Antiviral and immunoregulatory
properties produced by interacting with
specific receptor sites on cell surfaces
may explain beneficial effects.
Antiviral and immunoregulatory
properties produced by interacting with
specific receptor sites on cell surfaces
may explain beneficial effects.
Suppress inflammation & normal
immune response
Ataxia, Drowsiness, Fatigue, Psychosis,
Sedation, Vertigo, Blurred vision,
Pneumonitis, CHF, Hypertension, Hepatitis /
Pancreatitis,
Weight Gain, Urinary Retention / hesitancy,
Photosensitivity,
SIADH (syndrome of inappropriate antidiuretic
hormone), Agranulocytosis, aplastic anemia,
thrombocytopenia
Depression and suicidal ideations,
Seizures, headache, Weakness,
Conjunctivitis, Constipation, diarrhea,
dyspepsia, nausea, vomiting, Sweating
Menstrual disorders, Neutropenia,
myalgia, chills, fever, Flu-like symptoms,
pain, Elevated liver enzymes
Fluid retention, decrease Ca+
absorption and decrease K+, increase
BP, depression, euphoria, decrease
wound healing, increase glucose, mood
swings, long term use may cause
osteoporosis, skin fragility, hirsutism,
acne
Trigeminal Neuralgia Assessment:
Facial pain (location, intensity, duration)
Ask patient to identify stimuli that may
precipitate facial pain (hot or cold foods,
bedclothes, touching face, smoking, shaving,
brushing teeth)
Serum blood levels should be routinely
monitored during therapy.
Patient / Family Teaching:
Instruct patient to take medication around the
clock, as directed. Take missed doses as
soon as possible but not just before next
dose; do not double doses.
Medication may cause dizziness or
drowsiness. Advise patients to avoid driving
or other activities requiring alertness until
response to medication is known.
Instruct patients that fever, sore throat, mouth
ulcers, easy bruising, petechiae, unusual
bleeding, abdominal pain, chills, rash, pale
stools, dark urine, or jaundice should be
reported to health care professional
immediately.
Caution patients to use sunscreen and
protective clothing to prevent photosensitivity
reactions.
Advise female patients to use a nonhormonal
form of contraception while taking this
medication
Relief of pain in trigeminal neuralgia.
Prevention of seizures.
Decreased mania in Bipolar I disorder
Do not confuse products: Interferon
beta – 1a and Interferon beta – 1b ARE
NOT INTERCHANGEABLE.
Assess frequency of exacerbations of
symptoms of multiple sclerosis
periodically during therapy.
Monitor patient for signs of depression
during therapy.
Monitor hemoglobin, WBC, platelets,
and blood chemistries, including liver
function tests prior to and during
therapy.
Depression and suicidal ideations
Seizures, headache, Sinusitis
Upper respiratory tract infections
Chest Pain, heart failure, Abdominal
pain, nausea, dry mouth
UTI, urinary continence, polyuria
Alopecia, rash, Neutropenia, anemia,
thrombocytopenia
Injection-site reactions, Myalgia,
arthralgia, back pain, muscle spasm
Flu-like symptoms, Pain
Do not confuse products: Interferon
beta – 1a and Interferon beta – 1b
ARE NOT INTERCHANGEABLE.
Assess frequency of exacerbations of
symptoms of multiple sclerosis
periodically during therapy.
Monitor patient for signs of depression
during therapy.
Monitor hemoglobin, WBC, platelets,
and blood chemistries, including liver
function tests prior to and during
therapy.
Patient / Family Teaching:
Patient / Family Teaching:
Instruct patient / family correct
technique for drawing up medication,
injecting meds.
Instruct patient to take medication as
directed, prescribed dose and time
Flu-like symptoms may occur during
therapy. Acetaminophen may be used
for relief of fever and myalgias.
Caution patients to use sunscreen/
photosensitivity reactions
Drug may cause spontaneous abortion
Instruct patient / family correct
technique for drawing up medication,
injecting meds.
Instruct patient to take medication as
directed, prescribed dose and time
Flu-like symptoms may occur during
therapy. Acetaminophen may be used
for relief of fever and myalgias.
Caution patients to use sunscreen/
photosensitivity reactions
Drug may cause spontaneous abortion
Reduce incidence of relapse and slow
physical disability in patients with
multiple sclerosis
Reduce incidence of relapse and slow
physical disability in patients with
multiple sclerosis
Monitor blood sugars. Monitor WBC
and other signs of infection. Monitor
I&O and daily weight. Teach patient to
avoid abrupt discontinuation of
medication (should taper) Assess for
signs of Adrenal insufficiency. Assess
for Cushingoid appearance in patient
with long term use.
Decrease symptoms of multiple
sclerosis
CLASSIFICATION
MEDICATION
ROUTE OF ADMINISTRATION
INDICATIONS
ACTIONS
SIDE EFFECTS
NURSING IMPLICATIONS
Neurologic
Dopamine agonist
Anti-cholinergic
COMT inhibitors
Riluzole (Rilutek)
Levodopa/carbidopa (Simemet, Sinemet CR, Parcopa)
bromocriptine (Parlodel)
ropinirole (Requip)
pramipexole (Mirapex)
Apomorphine (Apokyn injection)
trihexyphenidyl (Artane)
benztropine (Cogentin)
Entacapone (Comtan)
Tolcapone (Tasmar)
Stalevo- (combination therapy of
carbidopa/levodopa/entacapone)
PO
Treatment of amyotrophic lateral
sclerosis
PO, injection
Parkinson’s motor symptoms
PO
Parkinson’s tremors
PO
Parkinson’s motor symptoms
Actions may be related to:
 Works by stimulating the parts of the brain that receive
dopamine therefore the brain thinks it is receiving it

Inhibition of glutamate release
 Supposed to help prevent dyskinesias and motor

Inactivation of sodium channels or
Interference with neurotransmitter binding fluctuations and maybe neuroprotective
at receptor sites
 Levodopa converts to dopamine by an enzyme in the brain
where is serves as a neurotransmitter
 Carbidopa prevents peripheral destruction of levodopa
therefor increasing the amount of levodopa to reach the
brain
Works by decreasing the
activity of acetylcholine
Blocks cholinergic
activity in the CNS
restoring the balance of
neruotransmitters
Blocks the breakdown of levodopa
therefore allowing more to reach the
brain.
Dizziness, weakness, headache
Decreased lung function
Hypertension, peripheral edema
Abdominal pain, anorexia, diarrhea,
dyspepsia, flatulence nausea, vomiting,
weight loss, Arthralgia, back pain,
Circumoral paresthesia
Use cautiously in patients with hepatic or
renal impairment
Use cautiously in female and Japanese
patients due to decreased metabolism
Hypotension, nausea, vomiting- levodopa/carbidopa
Headache, somnolence, back pain, nausea, vomiting,
edema and nightmares- Parlodel, Requip, Mirapex,
Apokyn
Blurred vision, dry
mouth, urinary retention.
Gastrointestinal upset, dizziness,
drowsiness and occasional increasein
dyskinesias, diarrhea
Monitor hepatic, renal function and CBC. Monitor blood
pressure and pulse during dosage adjustment. Assess
parkinsonian symptoms. Educate patient to change
position slowly if experiencing orthostatic hypotension.
Avoid alcohol and other CNS depressants. Do not stop
abruptly! (neuroleptic malignant syndrome)
Use cautiously with
glaucoma, tardive
dyskinesia, cardiac
arrhythmias, seizures,
prostate enlargement.
Assess for symptoms of Parkinsons.
Monitor patient for development of
diarrhea that usually occurs within 4-12
weeks of start of therapy.
Monitor for signs similar neuroleptic
malignant syndrome (Parkinson Crisis).
Don’t stop medication abruptly; taper
Patient / Family Teaching
EXPECTED OUTCOMES
Effects of drug may be decreased by
cigarette smoke, rifampin, omeprazole
Effects of drug may be decreased by
charcoal-broiled foods, high-fat meals
decrease absorption
Take medication on an empty stomach 1
hr or 2 hr after meals.
Effects may be increased by amitriptyline,
caffeine, fluoroquinolones, theophylline
Extended survival or time to
tracheostomy in ALS patients.
Monitor pulse, blood
pressure, bowel function,
urinary retention and
worsening of psychiatric
conditions.
Decrease in motor symptoms of Parkinsons
References
Adams, M., Josephson, D., & Holland, L. (2005). Pharmacology for nurses: a pathophysiologic approach. Upper Saddle River: Pearson Prentice Hall.
Deglin, J.H., & Vallerand, A. H. (2007). Davis’s drug guide for nurses (10th ed.).Philadelphia: F.A. Davis.
Gahart, B., & Nazareno, A. (2007). 2007 intravenous medications (23rd ed.).St. Louis: Mosby Elsevier
Decrease in tremors in
Parkinsons
Decrease in motor symptoms of
Parkinson’s
CLASSIFICATION
MEDICATION
ROUTE OF ADMINISTRATION
Monoamine oxidase type-B
Antiviral dopamine agonist
Neurologic
Amantadine (Symmetrel)
Tetrabenazine (Xenazine)
PO
Treatment of Parkinson motor symptoms
PO
Treatment of Huntingtons
blocks viral particle uncoating and nucleic acid
release into host cell, inhibiting viral replication;
exact mechanism in Parkinson dz unknown;
potentiates CNS dopaminergic responses
treats chorea, works to decrease the amount of dopamine
available at synapses in the brain and thus decreases the
involuntary movements
Arthralgia, increases in systolic blood
pressure, angina, depression, delirium,
postural hypotension, confusion, nausea
Monitor blood pressure, teach patient to avoid
tyramin containing foods (alcohol, caffeine,
OTC or herbal cough and cold medication)
because of the possible increase in blood
pressure and hypertensive crisis.
Do not give with opioid analgesics, SSRIs or
tricyclic antidepressants unless reviewed with
doctor/pharmacist.
Nausea, dizziness, insomnia, depression, anxiety,
arrhythmias, CHF, seizures, diarrhea, constipation,
peripheral edema, orthostatic hypotension
Somnolence, fatigue, depression, nausea, decrease in
appetite, ecchymosis, headache, dysphagia
Monitor blood pressure and neurological status.
Monitor I&O. monitor for edema.
Patient teaching:
Do not give with Flumist nasal influenza vaccine.
Do not drive until you know how it will effect you
with vision, thinking and dizziness.
Do not stop abruptly!
Monitor for symptoms of depression, behavior
changes, blood pressure, orthostatic blood pressures
Decrease in motor symptoms of
Parkinsons
Decrease in motor symptoms of Parkinsons
Decrease in symptoms of Huntingtons
Rasagiline (Azilect)
Selegiline (Eldepryl, Carbex)
Selegiline oral disintegrating tablet
(Zelapar)
PO
Treatment of Parkinson motor symptoms
INDICATIONS
ACTIONS
SIDE EFFECTS
NURSING IMPLICATIONS
EXPECTED OUTCOMES
MAO-B is an enzyme found in the brain that
has a major role in the metabolism of
dopamine in the brain. Therefore if these
medications can inhibit the enzyme it can help
conserve the available dopamine in the early
stage of PD and also allow lower does of
carbidopa/levodopa in the late-stage PD